Management of symptomatic deep venous thrombosis and pulmonary embolism on a neurosurgical service

Swann, Karl W.; Black, Peter McL.; Baker, Mary F.

doi:10.3171/jns.1986.64.4.0563

Cited by 41 publications

(5 citation statements)

References 25 publications

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“…Similar data was published by Swan et al 29. A delay of heparin treatment can be fatal as happened in one patient in our series and 38% of Swan's series.…”

Section: Discussionsupporting

confidence: 79%

Thromboembolic phenomena in neurosurgical patients operated upon for primary and metastatic brain tumours

et al. 1991

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A retrospective study was designed to evaluate clinical thromboembolic phenomena (TEP) in patients operated upon for brain tumours. Among 492 patients treated surgically in the supratentorial area, the overall incidence of clinical TEP was 7%. There were 5% with deep vein thrombosis (DVT) and 4% with clinical pulmonary embolism (PE). Seven patients (1%) died from massive PE. Among 141 patients treated surgically in the infratentorial area there were no episodes of TEP. Significant risk factors for TEP development were operations in the supratentorial area, malignant gliomas (compared to meningiomas) and para- or hemiparesis. Age, sex and the specific location in the supratentorial area were not found to be statistically significant risk factors. Among 12 patients who presented initially with DVT two developed PE despite full heparinization. 7/19 patients with PE died within minutes to hours of the clinical episode despite full conservative measures. In 2/26 patients who were treated with full heparinization complications occurred. There was one case of diffuse subcutaneous bleeding and one case of tumour bed haematoma. The identification of risk factors for the development of TEP will allow the implementation of prophylactic measures in appropriate patients undergoing elective brain tumour surgery.

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“…Similar data was published by Swan et al 29. A delay of heparin treatment can be fatal as happened in one patient in our series and 38% of Swan's series.…”

Section: Discussionsupporting

confidence: 79%

Thromboembolic phenomena in neurosurgical patients operated upon for primary and metastatic brain tumours

et al. 1991

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“…Large thrombi in the proximal venous system and/or pulmonary embolism must be treated promptly. Full anticoagulation of brain tumor patients has been considered generally safe, although there are no data on how soon after craniotomy anticoagulation can be initiated [23]. Anecdotal experiences suggest that anticoagulation may be safe as early as 24 hours after craniotomy.…”

Section: Discussionmentioning

confidence: 99%

“…However, experimental data in rats suggest an increased risk of intracerebral hemorrhage if anticoagulation therapy is initiated during the first 7 postoperative days [24]. Placement of a vena cava umbrella, on the other hand, carries a low risk when properly performed, but it does not help reduce the occurrence or sequelae of lower extremity thrombophlebitis [23,25,26].…”

Section: Discussionmentioning

confidence: 99%

Postoperative venous thromboembolism and brain tumors: part I. Clinical profile

et al. 1992

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Forty-six patients who underwent surgery for brain tumors were studied prospectively with 125I labeled Fibrinogen leg scans to detect postoperative venous thrombosis. The incidence of thrombosis was 72% for meningioma patients, 60% for glioblastoma patients, and 20% for brain metastasis patients.Correlation between the occurrence of venous thrombosis and the various clinical factors thought to be responsible for the high incidence of thrombosis generally failed to show statistical significance. This finding, along with the marked variation in the incidence of venous thrombosis between the different brain tumor groups, strongly suggests that biological factors play a more important role than clinical factors in determining which brain tumor patient will suffer a postoperative thrombotic event.A direct association between malignancies and thromboembolic complications has been well established, but the occurrence of these complications in patients with brain tumors has not received sufficient attention. Wetzel et al. reviewed a series of 6,065 neurosurgical patients [1] and found a 3% incidence of fatal postoperative pulmonary emboli; however, patients with brain tumors were not specifically identified [1]. In an autopsy study involving 334 patients with primary intracranial neoplasms, the incidence of venous thrombosis was 27.5%, statistically significantly different from the 17% incidence for a control neurosurgical group [2]. Several clinical studies have confirmed a high incidence of postoperative thrombophlebitis in neurosurgical patients [3][4][5][6][7][8][9], but brain tumor patients have rarely been studied separately.In another study, Ruff & Posner reported [10] that of 268 consecutive patients with malignant glioma, 36% developed clinical signs of systemic venous thrombosis. Choucair et al. [11], in their series of 715 patients, identified a 4% risk of venous thromboembolism after 6 weeks of the craniotomy. In none of these studies were the patients evaluated prospectively.We undertook this study with the hope of specifically identifying clinical risk factors and reliably estimating the incidence of postoperative clots detectable by 125I-labeled fibrinogen scans in patients with the three most common brain tumors [12,13]. Materials and methodsForty-six male patients operated on for glioblastoma, meningioma, or brain metastasis at the V.A.M.C. in Cincinnati were included in this study. Clinical data obtained preoperatively included patient age, side of the lesion, duration of symptoms, Karnofsky score, ambulatory status, and the presence of paresis.

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“…Venous thromboembolism is a common complication in patients who have undergone neurosurgery, Without thromboprophylaxis, the incidence of symptomless deep-vein thrombosis ranges between 2 0 and 50% (1)(2)(3)(4)(5), and fatal pulmonary embolism is reported to occur in 1.5 to 5% of patients (6)(7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

Low Molecular Weight Heparin and Compression Stockings in the Prevention of Venous Thromboembolism in Neurosurgery

et al. 1996

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SummaryPerioperative anticoagulant prophylaxis for postoperative venous thromboembolism (VTE) in neurosurgical patients has not gained wide acceptance due to the fear of intracranial bleeding. Physical methods give a worthwhile reduction of postoperative VTE but there still remains a substantial residual incidence. In other clinical indications, low molecular weight heparins have proven to be effective for prophylaxis of VTE when administered postoperatively, with the advantage of no bleeding enhancement during surgery.Therefore, we performed a multicentre, randomized, double-blind trial in neurosurgical patients to investigate the efficacy and safety of adding a low molecular weight heparin (LMWH), nadroparin, initiated postoperatively, to graduated compression stockings in the prevention of VTE. Deep-vein thrombosis was detected by mandatory venography. Bleeding was determined according to pre-defined objective criteria for major and minor episodes.An adequate bilateral venogram was obtained in 166 of 241 LMWH patients (68.9%) and 179 of 244 control patients (73.4%). A total of 31 of 166 LMWH patients (18.7%) and 47 of 179 control patients (26.3%) had VTE up to Day 10 postoperatively (p = 0.047). The relative risk reduction (RRR) was 28.9%. The rates for proximal deep-vein thrombosis/pulmonary embolism were 6.9% and 11.5% for the two groups, respectively (RRR: 40.2%; p = 0.065).Secondary analyses involved all VTE up to day 56 post-surgery which was detected in 33 patients of 241 in the LMWH group (13.7%) and 51 of 244 control patients (20.9%; RRR 34.5%; p = 0.018). The corresponding percentages for proximal deep-vein thrombosis/pulmonary embolism were 5.8% and 10.2% for the two groups, respectively, giving a RRR of 43.3%; p = 0.036. Major bleeding complications, during the treatment period, occurred in six low molecular weight heparin treated patients (2.5%) and in two control patients (0.8%); p = 0.087.A higher mortality was observed in the low molecular weight heparin group over the 56-day follow-up period (22 versus 10; p = 0.026). However, none of these deaths was judged by a blinded adjudication committee to be related to the study drug.In conclusion, this study demonstrates that the low molecular weight heparin, nadroparin, added to graduated compression stockings results in a clinically significant decrease in VTE without inducing any significant increase of major bleeding.

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Management of symptomatic deep venous thrombosis and pulmonary embolism on a neurosurgical service

Cited by 41 publications

References 25 publications

Thromboembolic phenomena in neurosurgical patients operated upon for primary and metastatic brain tumours

Thromboembolic phenomena in neurosurgical patients operated upon for primary and metastatic brain tumours

Postoperative venous thromboembolism and brain tumors: part I. Clinical profile

Low Molecular Weight Heparin and Compression Stockings in the Prevention of Venous Thromboembolism in Neurosurgery

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